Pyelonephritis Patients Research Articles

Pielonefrite Cronica: una Causa Misconosciuta di Perdita del Trapianto di Rene

Chronic pyelonephritis : a misunderstood cause of renal allograft loss Although urinary tract infections (UTI) are the most frequent infections in kidney transplant patients, there are no sufficient data about the prevalence of acute and chronic pyelonephritis and organ or patient survival. We present the clinical case of a young woman with a kidney transplant admitted to our Nephrology Clinic because of an acute worsening of renal function and a history of recurrent UTI. The renal biopsy showed medul lary tissue with a severe tubule-interstitial damage, suggestive for acute rejection, insomuch that steroids were prescribed. Due to the lack of any clinical improvement, a second biopsy was performed, showing a histological picture of chronic pyelonephritis with a severe and advanced damage. Subsequently, because of the severe renal failure the patient underwent peritoneal dialysis and transplant nephrectomy. This clinical case is exemplificative of the possible adverse outcomes of recurrent UTI that might lead in a short time to organ failure, highlighting the importance of a definitive histologic diagnosis.

Effects of Diabetes Mellitus and HbA1c on Treatment Prognosis in Uncomplicated Acute Pyelonephritis

Purpose: We investigated potential difference in the clinical features of hospitalized female acute pyelonephritis (APN) patients with and without diabetes mellitus (DM). The additional purpose of the study was to determine whether HbA1c has a role in predicting clinical outcome in terms of morbidity compared with those considered to have normal glycemic control in female APN patients with DM. Materials and Methods: Among the female patients who received inpatients care due to APN from January 2011 to December 2013, 282 patients (86 with DM and 196 without DM) were selected and their medical records were analyzed. Laboratory results (white blood cell, blood urea nitrogen, serum creatinine, fasting plasma glucose, HbA1c) were dichotomized. Primary outcomes for comparison between the groups of patients with or without DM were early clinical response rate and length of in-hospital stay. Subgroup analysis was also performed in DM patients according to HbA1c status (<6.5%, ≥6.5%). Results: In multivariate logistic regression analysis, DM was not found to show independent association with poor early clinical response or longer hospital stay. HbA1c was the common risk factor of poor early clinical response (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.61-14.8) and longer hospital stay (OR 4.20 95% CI 1.52-11.60) in APN patients with DM. Conclusions: Strict glucose control may be more important prognostic factor than presence or absence of DM in APN patients. As a marker of prolonged hospitalization and poor early clinical response, HbA1c can complement the present clinical and laboratory parameters used as guide in the proper treatment of DM patients with APN.

Draft Genome Sequence of the Multidrug-Resistant Clinical Isolate Dermabacter hominis 1368.

Dermabacter hominis is a common colonizer of the healthy human skin and is rarely detected as an opportunistic human pathogen. The genome sequence of the multidrug-resistant D. hominis strain 1368, isolated from blood cultures of a pyelonephritis patient, provides insights into the repertoire of antibiotic resistance genes.

Is Urinary Tumor Necrosis Factor Alpha a Predictor of Urological Abnormality in Children

Introduction: The role of urinary Tumor Necrosis Factor Alpha (TNF-α) in the diagnosis and treatment of different disorders has been evaluated recently. This study was conducted to evaluate the correlation of urinary TNF-α with urological abnormalities in pediatric pyelonephritis. Materials and Methods : This prospective study was conducted on children with acute pyelonephritis. Urine samples were tested for TNF-α (ELISA colorimetric, SANQUINE, USA) and creatinine in study group. Renal ultrasonography and voiding cystoureterography were performed in all patients, as well. Results: One hundred pyelonephritic patients were enrolled in the study. Urinary TNF-α/Cr was in an abnormal range in 91.9% of the patients. This query revealed a significant correlation between urinary TNF-alpha and kidney ultrasound results (r=0.59) and grading of reflux in voiding cystoureterography (r=0.128). Furthermore, our study showed a significant difference between the level of urinary TNF-α/Cr in patients with and without abnormality on kidney ultrasonography (p value < 0.000). Conclusions: The results of this study indicate the efficacy of urinary TNF-α in detection of inflammatory disorders such as pyelonephritis and pediatric urological abnormalities. Keywords : Tumor Necrosis Factor-alpha; Urologic Diseases; Child.

Frequency of Massive Proteinuria in Childhood Pyelonephritis and the Response to Antibiotic Therapy

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood which can contribute to high blood pressure and renal failure later in life. There are diffident methods for evaluation of a child with UTI for differentiation of cystitis from acute pyelonephritis. One of which is measuring protein in urine. The aim of this study is to investigate the role of UTI in provoking proteinuria. Material and Methods: This is Quasi- experimental study, before and after, in patients with acute pyelonephritis in Mofid Children's Hospital during 2004-2006. All pyelonephritic patients were treated by intravenous ceftriaxone for at least for 10 days. Random urine samples were taken from all patients at the onset of admission before starting the antibiotic and at the ninth day of treatment for the evaluation of urine protein and creatinine. Results: 152 children between 1 to 2 years of age entered the study. The prevalence of proteinuria in the acute phase of pyelonephritis was 94.8%. According to our study the prevalence of proteinuria during pyelonephritis is higher in children less than 2 years old (97.3%) and 20% of patients showed nephrotic range of proteinuria. In all cases random urine samples were normal after completion of treatment (p<0.005). Conclusions: the results of this study illustrate that proteinuria has a high frequency during UTI and acute pyelonephritis. Proteinuria during pyelonephritis may be massive and in the nephrotic range but should not be the cause of concern because in the majority of cases it disappears following treatment. Keywords : Pyelonephritis; Proteinuria; Antibiotics; Child.

A Research of the Microfluidic Cell Chip Technology to Reduce Urine Cells Overlap Rate

Objective: Employ a new a method using Microfluidic Cell Chip improve the recognition rate of cells in urine. This method will decrease errors caused by failure to distinguish cell in urine based on the overlapping cell morphology characteristics and cell parameters. Methods: (1) enroll 60 patients respectively of acute glomerulonephritis, acute pyelonephritis and acute cystitis, employ WB-2000 automated urine analyzer to detect 9 kinds of biochemical indexes urine protein, glucose, ketone, uric bilirubin and urobilinogen, nitrite, pH, erythrocytes and leukocytes. (2) Observe the overlap count of erythrocytes and leukocytes in the urine of three groups of patients, and calculate overlap rate of erythrocytes and leukocytes of each group of the patient's respectively. (3) After separating urine cells with Microfluidic Cell Chip technology, test the overlap rate of erythrocytes and leukocytes. Results: (1) The overlap rate of erythrocytes in acute glomerulonephritis patients is 8.53% ~ 8.72%, and the overlap rate of leukocytes is 15.51% ~ 17.18%; The overlap rate of erythrocytes in pyelonephritis patients is 3.64 ~ 4.95%, while the overlap rate of leukocytes is from 8.18 to 9.23%; The overlap rate of erythrocytes in cystitis patients is between 3.85% and 4.53%, and the overlap rate of leukocytes is 8.71% ~ 7.85%; In the glomerulonephritis group, the protein in urine is in the highest levels, the overlap rate of erythrocytes and leukocytes is higher than other groups significantly. (2) the Microfluidic Cell Chip technology can reduce the urinary cells overlap rate of three groups of patients, to levels of 0.22% ~ 0.28%. Conclusion: Microfluidic Cell Chip technology did reduce the overlap rate of erythrocytes and leukocytes in urine samples from patients with three different urinary tract disease.

Draft Genome Sequence of Uropathogenic Escherichia coli Strain J96

Escherichia coli J96 (O4:K6) was isolated from a human pyelonephritis patient. Here, we report the draft genome sequence of E. coli J96, which contains virulence genes, including adhesion factors, alpha-hemolysins, and cytotoxic necrotizing factor. J96 infects the kidney and bladder, making it an important tool for studying E. coli pathogenesis.

Polymicrobial Endophthalmitis in a Patient with Pyelonephritis

The genitourinary tract is well recognized as a route through which bacteria could gain access to the blood circulation. Under some circumstances, metastatic infections rarely occur in distant organs, including the eye. Endogenous endophthalmitis is a relatively uncommon but severe infection, and has a varied aetiology [1,2]. Moreover, polymicrobial infections in endophthalmitis are extremely uncommon, and are often associated with trauma [3]. However, polymicrobial infections in the eye of pyelonephritis patients have yet to be reported. We, herein, report a patient with pyelonephritis, who rapidly developed severe polymicrobial endogenous endophthalmitis.

The Authors Reply: Relationship Between Spontaneous Passage Rates of Ureteral Stones Less Than 8 mm and Serum C-Reactive Protein Levels and Neutrophil Percentages

To the editor: I appreciate the comments of the author of the critique of Relationship between spontaneous passage rates of ureteral stones less than 8 mm and serum C-reactive protein levels and neutrophil percentages. The purpose of our study was to assess the usefulness of C-reactive protein (CRP) and neutrophil percentages as an indicator of the spontaneous passage rates of ureteral stones that are less than 8 mm in size. CRP is a nonspecific acute phase reagent for which plasma levels are severely elevated in proportion to the inflammatory stimulus. The normal concentration in healthy human serum is usually lower than 1 mg/dL and slightly increases with aging. Higher levels are found in pregnant women near the end of pregnancy, with mild inflammation and viral infections (1-4 mg/dL), and with active inflammation, bacterial infection (4-20 mg/dL), and severe bacterial infections and burns (>20 mg/dL) [1]. Likewise, the normal range of CRP in our institution is also lower than 0.5 mg/dL. Angulo et al. [2] emphasized that the risk of early sepsis or occult sepsis is present if the CRP of the patients who have ureteric stones is elevated. In their study, the average CRP level of the diversion group was 13.9 mg/dL. In our study, however, the average CRP of the spontaneous passage group was 4.1 mg/dL and the average CRP of the no passage group was 8.3 mg/dL. The CRP levels of 90.3% of the patients (169 of 187 patients) were less than 5 mg/dL. Likewise, the stone sizes were smaller than those in Angulo et al. [2]'s study. In our study, we excluded patients who had acute or chronic infections. This shows that patients in our experiment had a lesser inflammatory state. Usually, the CRP level of the acute infection state is high. Chung et al. [3] studied the CRP level of patients who had acute uncomplicated pyelonephritis. The average CRP level of those pyelonephritis patients was 11.8 mg/dL. Paick et al. [4] studied the CRP level of patients with acute pyelonephritis. The initial mean CRP was 11.4 mg/dL. They categorized acute pyelonephritis into 4 grades according to renal parenchymal involvement. The CRP of the patients who did not have renal parenchymal involvement was 3.7 mg/dL, that of cases with less than 25% involvement was 6.8 mg/dL, that of cases with involvement between 25% and 50% was 12.4 mg/dL, and that of cases with more than 50% involvement was 21.8 mg/dL. I think the patients who have no evidence of acute urinary infection or have low CRP are not in need of urinary diversion. In the study by Angulo et al. [2], the mean CRP value was 4.7 mg/dL. Aldaqadossi [5] reported that the CRP of spontaneous stone expulsion patients was 1.6 mg/dL, and the CRP of the patients who failed to pass the stone spontaneously was 3.9 mg/dL. These CRP level divisions were similar to those in our study. But the limitation of our study was that we did not define the cutoff level of CRP that predicts the spontaneous passage of ureteric stones. In many studies, stone size was the most predictive factor for spontaneous passage of ureteric stones. In our study, the mean stone sizes were not that different in either the spontaneous passage group or the no spontaneous passage group (3.7 mm vs 4.4 mm, p=0.116). Also, the majority of stones were very small. I think that the spontaneous stone passage in our study was not affected by the size of the stones. Our institution follows the relationship of urinary stones and the CRP level. The results of this study are preliminary. In the future, we will report more advanced data when additional cases are studied.

Assessment of Toll‐like receptor‐4 gene polymorphism on pyelonephritis and renal scar

The aim of this study was to evaluate the effect of the TLR-4 gene TLR4 c.896A < G polymorphism on the development and clinical severity of urinary tract infections (UTI) and renal scar formations in children. The patients with first diagnosis of UTI (n = 112) and healthy controls (n = 93) were enrolled in the study. The TLR4 c.896A < G polymorphism was analysed in groups. The mean age of the patients in the study group was 8.1 ± 3.5 years and 9.2 ± 2.7 years for those in the control group. The TLR4 c.896A < G polymorphism was detected in 12.5% in the UTI group and in 15.1% of the control group. Forty patients showed pyelonephritis (PN) with scar tissue, 37 patients had PN without scars, and 35 patients had lower UTI. The TLR4 c.896A < G polymorphism was found in 22.5% of patients with scar-positive PN, and it was also present in 10.8% of patients with scar-negative PN and 2.9% of patients with lower UTI. We found higher TLR4 c.896A < G polymorphism and allelic frequency in patients with upper UTI compared to patients with lower UTI (P = 0.041 and P = 0.039, respectively). No significant difference was observed between patients and the control group for TLR-4 c.896A3. The TLR4 c.896A < G polymorphism and alleles were higher in patients with upper UTI than in patients with lower UTI. The TLR4 c.896A < G polymorphism frequency was nearly twice that in the scar-positive PN patients when compared to the scar-negative patients. Larger-scale studies involving larger numbers of patients should be performed.

Risk factors of septic shock in bacteremic acute pyelonephritis patients admitted to an ER

Our objective was to identify factors associated with septic shock in patients with bacteremic acute pyelonephritis who were admitted to our emergency department (ER). We performed a retrospective cohort study of 208 adult cases compiled between January 2000 and December 2010. The mean age of the 208 predominantly female (81.3%) adult cases enrolled during the study period was 65.9 ± 15.2 years. The overall mortality rate was 6.7% (14/208), but the mortality rate of 54 patients (26%, 54/208) who initially presented with shock was 25.9% (14/54). Multiple logistic regression analyses revealed that the independent risk factors for the occurrence of septic shock were the presence of a urinary tract obstruction (OR 4.391, 95% CI 1.782-10.821, P = 0.001), healthcare-associated infection (OR 3.491, 95% CI 1.585-7.692, P = 0.002), and liver cirrhosis (OR 4.609, 95% CI 1.395-15.222, P = 0.012). Therefore, physicians should be aware that appropriate early management is necessary to prevent fatal outcomes in patients with risk factors of septic shock.

Serum ratio of soluble triggering receptor expressed on myeloid cells-1 to creatinine is a useful marker of infectious complications in myeloperoxidase-antineutrophil cytoplasmic antibody-associated renal vasculitis

The contribution of infections to the mortality of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis patients is important and should induce early and careful control of these events. However, the differentiation of infection from active vasculitis is often difficult. The usefulness of serum-soluble triggering receptor expressed on myeloid cells-1 (TREM-1) for detecting the presence of infectious complications regardless of disease activity was investigated. Soluble TREM-1 in serum obtained from 41 patients with myeloperoxidase (MPO)-ANCA-associated vasculitis was measured by an enzyme-linked immunosorbent assay. Twenty-nine samples were from active vasculitis patients, 27 samples from inactive vasculitis patients without infection and 17 samples from inactive vasculitis patients with infectious complications. Serum-soluble TREM-1 was also measured in 10 patients with acute pyelonephritis and 30 patients with chronic kidney disease (CKD). There was a significant correlation between serum levels of soluble TREM-1 and serum creatinine levels among all patients (r = 0.554, P < 0.0001). The serum-soluble TREM-1/creatinine ratio was higher in inactive vasculitis patients with infectious complications than in active vasculitis, inactive vasculitis without infection and CKD patients (P = 0.0005, P < 0.0001 and P < 0.0001, respectively), but not significantly different to that in acute pyelonephritis patients. On receiver-operating-characteristic curve analysis, a lower-limit value of 9.40 ng/mg for this ratio had a sensitivity of 84.6% and a specificity of 90.8% in differentiating patients with infection from those without infection. The serum ratio of soluble TREM-1 to creatinine may be a useful marker for detection of infectious complications in MPO-ANCA-associated vasculitis.

Urine macrophage migration inhibitory factor (MIF) in children with urinary tract infection: a possible predictor of acute pyelonephritis

Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory cytokine expressed at sites of inflammation. We have assessed this factor (MIF) in urinary tract infections with the aim of determining a non-invasive and sensitive method to differentiate upper and lower renal involvement. Thirty-three pediatric patients with urinary track infection (25 with acute pyelonephritis, eight with acute cystitis) and 40 healthy subjects were recruited for this prospective case-control study. Pyelonephritis was differentiated from cystitis by dimercaptosuccinic acid (DMSA) scan. Urinary MIF concentration was determined using an enzyme-linked immunosorbent assay method. The urine MIF/creatinine (Cr) ratio was significantly higher in pyelonephritis patients than in those with acute cystitis and the control group (P < 0.001). The optimal cut-point of 4.90 pg/micromol Cr for the urine MIF/Cr ratio has the potential to be a biomarker for distinguishing patients with acute pyelonephritis from those with acute cystitis. Determination of the urinary MIF was also useful in selecting the patients at risk of permanent renal damage. Of those patients with pyelonephritis, based on the DMSA scan at the time of infection, scarring on follow-up DMSA scan 9-12 months later occurred in patients with the highest urinary MIF/Cr ratios. We conclude that the urine MIF/Cr ratio is a sensitive test for differentiating acute pyelonephritis from acute cystitis and also for detecting children with acute pyelonephritis who are at a higher risk for permanent renal scars in the future.

Role of host and bacterial virulence factors in Escherichia coli spontaneous bacterial peritonitis

Host factors and bacterial virulence determinants may play a role in Escherichia coli (E. coli) spontaneous bacterial peritonitis. We evaluated the importance of these factors in the emergence of fluoroquinolone-resistant strains and outcome in cirrhotic patients with E. coli spontaneous bacterial peritonitis. E. coli spontaneous bacterial peritonitis was detected in a 2-year period in three tertiary hospitals. Clinical and bacteriological data were obtained. Phylogenetic group and 15 virulence genes of E. coli strains were analyzed by polymerase gene reaction and compared with 50 isolates from pyelonephritis patients. Forty-seven E. coli spontaneous bacterial peritonitis patients were identified, 18 (38%) were fluoroquinolone-resistant, a 12% increase compared with our earlier series from 1997 to 2002. Fluoroquinolone resistance was associated with norfloxacin prophylaxis, increased resistance to trimethoprim-sulfamethoxazole and cefotaxime, and less bacterial virulence, as demonstrated by a higher prevalence of 'nonpathogenic' phylogenetic groups A+B1 (56 vs. 28%; P=0.04) and lower virulence scores in fluoroquinolone-resistant E. coli compared with fluoroquinolone-susceptible E. coli. E. coli strains from cirrhotic patients belonged more frequently to 'nonpathogenic' phylogenetic groups A+B1, had fewer virulence factors and higher rates of fluoroquinolone resistance than isolates from pyelonephytis patients. Immunosuppression was independently associated with in-hospital and 3-month mortality. Bacterial virulence factors were unrelated to mortality. Fluoroquinolone-resistant E. coli spontaneous bacterial peritonitis prevalence is increasing because of norfloxacin prophylaxis. Strains from peritonitis are less virulent than strains from pyelonephritis because of a higher prevalence of A+B1 phylogeny and quinolone resistance. Mortality is related to immunosuppression, but not to bacterial virulence factors.

Bacterial infection-mediated mucosal signalling induces local renal ischaemia as a defence against sepsis

Ascending urinary tract infections can cause extensive damage to kidney structure and function. We have used a number of advanced techniques including multiphoton microscopy to investigate the crucial early phases of uropathogenic Escherichia coli induced pyelonephritis within a living animal. Our results reveal a previously undescribed innate vascular response to mucosal infection, allowing isolation and eradication of the pathogen. The extremely rapid host response to mucosal infection was highlighted by the triggering of a cascade of events within 3-4 h. Epithelial signalling produced an increase in cellular O(2) consumption and affected microvascular flow by clotting, causing localized ischaemia. Subsequent ischaemic damage affected pathophysiology with actin re-arrangement and epithelial sloughing leading to paracellular bacterial movement. A denuded tubular basement membrane is shown to hinder immediate dissemination of bacteria, giving the host time to isolate the infection by clotting. Suppression of clotting by heparin treatment caused fatal urosepsis. Clinically these findings may be relevant in antibiotics delivery in pyelonephritis patients and to the use of anticoagulants in sepsis.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis

Purpose: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. Materials and Methods: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. Results: The mean age of the patients was 43.2±16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9±5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014±5,778/mm, 74.8± 14.5%, 44.0±32.0 mm/hr, 12.4±9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups ( 61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. Conclusions: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan. (Korean J Urol 2007;48:29-34)

ELEVATED PLASMA TGF-β1 IN RENAL DISEASES: CAUSE OR CONSEQUENCE?

We previously reported elevated levels of TGF-β1 in patients with renal carcinoma. Certain aspects led us to ask whether they might be caused by chronic damage to the kidney(s). Here we report on an extended set of patients with various renal diseases, lung cancer, humoral immunodeficiency and controls. For latent TGF-β1 in plasma, we find that the control, immunodeficiency, lung cancer and kidney transplant groups do not differ significantly (means, 7.0–8.8ng/ml). Also, acute short-term renal stress (extracorporal lithotrypsy) does not lead to an increase of TGF-β1. However, the pyelonephritis patients present with levels of 19.0ng/ml, chronic extracorporal dialysis patients with 15.5ng/ml, and renal cell carcinoma patients with 22.8ng/ml. For active TGF-β1 these findings are exactly recovered. For serum levels, only the renal carcinoma group presents with significantly elevated levels of TGF-β1. Kidney transplantation seems to normalize TGF-β1 levels, while in the kidney cancer patients surgery has an effect only in part of the group. We conclude that elevated plasma TGF-β1 levels are common in at least two chronic renal disease conditions, and that it normalizes with restoration of renal function. It is tempting to speculate that chronic elevation of TGF-β1 in these patients may be critically involved in these conditions predisposing to renal cancer.

Application of bromodeoxyuridine (BrdU)-labelled Escherichia coli strains in studies on their adherence to human endothelial cells

Fimbriated and fimbria-less strains of Escherichia coli were isolated from urine of pyelonephritis patients, labelled with bromodeoxyuridine and their adhesion to human umbillical vein endothelial cells was studied employing ELISA and immunocytochemistry. No significant differences were noted in adhesion of the two types of strains.

In Vivo Phase Variation of Escherichia Coli Type 1 Fimbrial Genes in Women With Urinary Tract Infection

Type 1 fimbriae, expressed by most Escherichia coli strains, are thought to attach to human uroepithelium as an initial step in the pathogenesis of urinary tract infections (UTI). Numerous reports using both in vitro and murine models support this role for type 1 fimbriae in colonization. Unfortunately, only a limited number of studies have directly examined the expression of fimbriae in vivo. To determine whether type 1 fimbrial genes are transcribed during an acute UTI, we employed a modification of an established method. The orientation (ON or OFF) of the invertible promoter element, which drives transcription of type 1 fimbrial genes, was determined by PCR amplification using primers that flank the invertible element, followed by SnaBI digestion. The orientation of the type 1 fimbrial switch was determined under three experimental conditions. First, E. coli strains from different clinical sources (acute pyelonephritis patients, cystitis patients, and fecal controls) were tested under different in vitro culture conditions (agar versus broth; aerated versus static). The genes in the more-virulent strains (those causing acute pyelonephritis) demonstrated a resistance, in aerated broth, to switching from OFF to ON, while those in fecal strains readily switched from OFF to ON. Second, bladder and kidney tissue from CBA mice transurethrally inoculated with E. coli CFT073 (an established murine model of ascending UTI) was assayed. The switches directly amplified from infected bladder and kidney tissues were estimated to be 33 and 39% ON, respectively, by using a standard curve. Finally, bacteria present in urine samples collected from women with cystitis were tested for type 1 fimbria switch orientation. For all 11 cases, an average of only 4% of the switches in the bacteria in the urine were ON. In 7 of the 11 cases, we found that all of the visible type 1 fimbrial switches were in the OFF position (upper limit of detection of assay, 98% OFF). Strains recovered from these urine samples, however, were shown after culture in vitro to be capable of switching the fimbrial gene to the ON position and expressing mannose-sensitive hemagglutinin. The results from experimental infections and cases of cystitis in women suggest that type 1 fimbrial genes are transcribed both in the bladder and in the kidney. However, those bacteria found in the urine and not attached to the uroepithelium are not transcriptionally active for type 1 fimbrial genes.

Influence of acetate and bicarbonate dialysate on blood short- and long-chain acyl carnitine in adult pyelonephritis patients.

The effect of acetate and bicarbonate haemodialysis (HD) on the concentrations of erythrocyte, whole-blood and plasma total carnitine (TC), free carnitine (FC), short- (SC) and long-chain acylcarnitine (LC) and acylcarnitine (AC) as well as the ratio of AC to FC was investigated in 30 healthy subjects (15 men and 15 women) and 27 patients (10 men and 17 women) with chronic pyelonephritis (CPN) undergoing chronic HD. Fourteen patients (5 men and 9 women) used acetate HD and the remainder (5 men and 8 women) used bicarbonate HD. The mean predialysis erythrocyte, whole-blood and plasma concentrations of TC, FC, SC, LC and AC as well as the ratio of AC to FC were not significantly different from those in healthy controls (P > 0.05). However, after acetate or bicarbonate HD, a significant decrease in erythrocyte, whole-blood and plasma concentrations of TC, FC, SC, LC and AC were found, compared with either predialysis or healthy control values (P < 0.001). Furthermore, the ratio of AC to FC was significantly higher following acetate HD as compared with either acetate or bicarbonate predialysis values (P < 0.001). The observed variations in response between acetate and bicarbonate HD may be due to enhanced formation of acetyl-coenzyme A and fatty acid synthesis during acetate HD.